Analyst, Healthcare Coding - Disputes, Claims amp Investigations

📋 Description

• • Own end-to-end forensic analyses of multi-million-dollar hospital revenue cycles, dissecting Epic Resolute charge-capture workflows, claims-editing logic, and payer-specific reimbursement rules to surface fraud, waste, abuse, and systemic inefficiencies that directly impact client bottom lines.
• • Design and execute data-driven compliance reviews that translate complex EMR/EHR data sets into clear, defensible findings for internal audit committees, external counsel, and regulatory bodies such as CMS and state Medicaid agencies.
• • Partner with senior consultants and legal counsel to build litigation-ready evidence packages—gathering documentation, mapping billing anomalies to regulatory violations (e.g., False Claims Act, HIPAA), and crafting corrective-action roadmaps that withstand scrutiny in court or settlement negotiations.
• • Lead or support full-lifecycle EMR/EHR optimization projects—from pre-implementation gap analyses through post go-live validation—ensuring new systems sustain compliant revenue integrity while maximizing net revenue realization.
• • Translate technical discoveries into board-level narratives: prepare executive dashboards in Power BI/Tableau, draft concise PowerPoint briefs, and present risk-ranked recommendations that enable C-suite decision-making within tight regulatory deadlines.
• • Serve as the primary day-to-day client contact on select engagements, coordinating across finance, compliance, HIM, and IT teams to align project milestones, manage change requests, and maintain Relentless Excellence in service delivery.
• • Continuously monitor evolving CMS regulations, NCCI edits, payer bulletins, and OIG work plans; distill changes into actionable guidance that protects clients from emerging compliance exposures and positions Stout as a thought leader.
• • Contribute to internal knowledge capital by authoring whitepapers, developing reusable analytic scripts, and mentoring junior staff—accelerating the collective expertise of the Healthcare Consulting practice and driving firmwide growth.
• • Travel up to 25% to provider sites, legal offices, and regulatory hearings, ensuring on-the-ground insights and real-time problem-solving that remote analysis alone cannot achieve.
• • Demonstrate Stout’s core values in every interaction: remain Positive and Team-Oriented when navigating high-stakes disputes, stay Accountable for deliverable quality, foster Relationship-Focused partnerships that extend beyond single engagements, and maintain Super-Responsive communication that clients equate with trust.